Barriers to and Facilitators of Postpartum Home Blood Pressure Monitoring after Hypertensive Disorders of Pregnancy: A Qualitative Study

Abstract Background Hypertensive disorders of pregnancy (HDP) affect more than 10% of US pregnancies and are associated with a twofold higher lifetime risk of cardiovascular disease. Postpartum home blood pressure monitoring (HBPM) improves outcomes after HDP, yet there are gaps in both uptake and retention in real-world settings. Objective To identify barriers to and facilitators of postpartum HBPM to inform future implementation strategies. Design We conducted semi-structured, individual interviews. Participants The participants were 26 postpartum women with HDP recruited at the University of California, San Francisco. Approach Interviews were conducted between January and December 2025. Using a rapid qualitative analysis approach informed by the Capability, Opportunity, Motivation, and Behavior (COM-B) model, we identified barriers to and facilitators of postpartum HBPM. Key Results Barriers to postpartum HBPM spanned all COM-B domains and included knowledge gaps about blood pressure (BP) measurement technique and the long-term cardiovascular risks of HDP, reduced memory and attention postpartum, competing newborn caregiving demands, disrupted daily routines, fragmented postpartum care, limited insurance coverage for BP cuffs, and delivery-related trauma and anxiety. Facilitators included prior knowledge of HDP, anchoring BP measurement to daily routines, in-office validation of BP cuffs, Bluetooth-enabled BP cuffs with automatic data transmission to the electronic health record, accountability to the healthcare team, concern about long-term cardiovascular risk, and motivation to stay healthy for their children. Conclusions We identified modifiable barriers and facilitators across COM-B domains that influence postpartum HBPM engagement among women with HDP. Targeted interventions addressing these barriers and leveraging these facilitators may improve postpartum HBPM uptake. Future studies should use these findings to develop and test implementation strategies for this high-risk population.